Obesity surgery · 2026
Metabolic Bariatric Surgery for Cancer Prevention and Risk Reduction in Patients with Obesity: A GRADE-Based International Federation for the Surgery and Other Therapies for Obesity (IFSO) Position Statement.
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Belluzzi Amanda, De Luca Maurizio, Vitiello Antonio, Cohen Ricardo, Aminian Ali, Salminen Paulina, Nimeri Abdelrahman, Di Lorenzo Nicola, Angrisani Luigi, Copaescu Catalin, Petry Tarissa, Ponce Jamie, Haddad Ashraf, Kow Lilian, Monami Matteo
Аннотация
BACKGROUND: Obesity is a major increasing driver of cancer burden worldwide, and intentional weight loss has emerged as a potential strategy for cancer risk reduction. Metabolic bariatric surgery (MBS) achieves sustained weight loss, but its role in cancer prevention remains uncertain. This GRADE-based International Federation for the Surgery and Other Therapies for Obesity (IFSO) position statement aimed to synthesize contemporary evidence on MBS and cancer outcomes and translate it into clinically actionable recommendations.
METHODS: A systematic review according to PRISMA guidelines was performed searching MEDLINE and EMBASE up to 8th March 2026. Two questions were formulated addressing MBS versus non-surgical weight-loss interventions and comparative effectiveness of MBS procedures for reducing cancer incidence. Evidence was appraised using GRADE principles.
RESULTS: There were no RCTs enrolling adults with obesity reporting cancer incidence after MBS. The search identified 191 records, of which 26 were included in the qualitative synthesis and a maximum of seven contributed to any single quantitative pooled estimate. Across retrospective matched cohorts, MBS was generally associated with lower incidence of several obesity-related malignancies, with point estimates favoring MBS for most cancer sites. Pooled random-effects estimates included breast cancer (IRR 0.85, 95% CI 0.80-0.91), endometrial cancer (IRR 0.38, 95% CI 0.23-0.61) and colorectal cancer (IRR 0.72, 95% CI 0.59-0.88); certainty of evidence was low to very low for all outcomes. Reported reductions were most consistent for hormone-sensitive cancers but also observed across multiple gastrointestinal and other sites with variable heterogeneity. Sensitivity analyses incorporating modern obesity management medications (OMMs) also suggested cancer incidence reductions across several sites, supporting sustained weight loss as a mediator of cancer risk reduction.
CONCLUSIONS: Current evidence suggests that MBS is associated with reduced incidence of several obesity related cancers. However, the certainty of the evidence is limited by residual selection bias, and heterogeneity.
METHODS: A systematic review according to PRISMA guidelines was performed searching MEDLINE and EMBASE up to 8th March 2026. Two questions were formulated addressing MBS versus non-surgical weight-loss interventions and comparative effectiveness of MBS procedures for reducing cancer incidence. Evidence was appraised using GRADE principles.
RESULTS: There were no RCTs enrolling adults with obesity reporting cancer incidence after MBS. The search identified 191 records, of which 26 were included in the qualitative synthesis and a maximum of seven contributed to any single quantitative pooled estimate. Across retrospective matched cohorts, MBS was generally associated with lower incidence of several obesity-related malignancies, with point estimates favoring MBS for most cancer sites. Pooled random-effects estimates included breast cancer (IRR 0.85, 95% CI 0.80-0.91), endometrial cancer (IRR 0.38, 95% CI 0.23-0.61) and colorectal cancer (IRR 0.72, 95% CI 0.59-0.88); certainty of evidence was low to very low for all outcomes. Reported reductions were most consistent for hormone-sensitive cancers but also observed across multiple gastrointestinal and other sites with variable heterogeneity. Sensitivity analyses incorporating modern obesity management medications (OMMs) also suggested cancer incidence reductions across several sites, supporting sustained weight loss as a mediator of cancer risk reduction.
CONCLUSIONS: Current evidence suggests that MBS is associated with reduced incidence of several obesity related cancers. However, the certainty of the evidence is limited by residual selection bias, and heterogeneity.